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The likelihood of a child being a bully triples if the child has a mental health disorder, according to a study conducted by Frances Turcotte-Benedict GS, a teaching fellow in pediatric emergency medicine at Hasbro Children's Hospital. Turcotte-Benedict presented her results at the national conference of the American Academy of Pediatrics in New Orleans Oct. 22.
Turcotte-Benedict analyzed the relationship between mental health diagnoses in children and bullying behavior based on data gathered in the 2007 National Survey of Children's Health. She also examined the correlation by disorder subtype, comparing bullying behavior of children with ADHD, anxiety, depression and Oppositional Defiant Disorder.
Children with depression were  three times more likely to be bullies, while those with Oppositional Defiant Disorder were six times as likely to exhibit bullying, which is defined as "repetitive, intentional aggression that involves a disparity of power between the victim and perpetrator," according to an AAP press release.
Turcotte-Benedict said she found the association between bullying behavior and depression "shocking," as children with depression are usually described as being introverted. But "depression manifests differently in children and adults," Turcotte-Benedict said, noting that depression sometime leads children to exhibit aggressive behavior toward others.
While bullying is a "popular topic in the media," and there is an "overwhelming amount of information out there about children who are victims of bullying," studying the mental health of bullies themselves is less charted territory, Turcotte-Benedict said.
"If we really want to learn more about this problem, we need to focus more on the kids who are doing the bullying," Turcotte-Benedict said.
The study is unique because it spans such a large age group - children in elementary, middle school and high school, Turcotte-Benedict said. Most bully studies focus only on middle schoolers, where bullying is considered to be at its peak, she said. Turcotte-Benedict's age-stratified analysis proved that bullying is just as prevalent in elementary school as in the later years and while a peak did occur in middle school, the discrepancy was not statistically significant. Twenty percent of high school students reported having been bullied within the last 12 months, according to the AAP release.
"It's important for us to start early in bully prevention," Turcotte-Benedict said.
One "limitation" of the study was that the data were parent-reported, and parents may be unaware or hesitant to disclose their child's bullying behavior, Turcotte-Benedict said.
"It would have been more accurate to survey teachers - they are the ones who are actually witnessing this in their classrooms," she said. The National Survey of Children's Health interviews nearly 92,000 families by telephone.
Despite this limitation, Turcotte-Benedict said the study's bullying and mental health rates were comparable to other studies - with approximately 16 percent of children suffering from mental health disorders.
Turcotte-Benedict said her interest in the topic of youth violence stems from her interactions in the emergency room with children diagnosed with mental health disorders. This study emerged from an individual study conducted in the two-semester PHP 2507-2508: "Biostatistics and Data Analysis" course taught by Annie Gjelsvik '91 PhD'03, assistant professor of community health and co-author of the study.
Gjelsvik said Turcotte-Benedict's study was "rare" in the way it has been presented at a major national conference - an opportunity achieved by only one other student out of the 42-student class.
"It was great the way she was able to hone in on a topic that is so timely and so important," Gjelsvik said. "Every professor wants their student to have practical applications for what they are learning."
Turcotte-Benedict said she hoped her presentation to the AAP "heightened the awareness of bullying to pediatricians."
In addition, Turcotte-Benedict said she wants her study to reach policymakers and schools - groups who have recognized the prevalence of bullying and enacted anti-bullying laws but could do more, she said.
"We need to take it to the next level," Turcotte-Benedict said, noting the need to re-evaluate which of these programs are most effective and combining mental health counseling and anti-bullying programs in schools.


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